Bradley Williams
2-6-15
Anaya 1st hour
Code Blue Discussion Questions
Chapter 1
1. From what you have read in chapter one complete the following personality profile for
Hap Castleton and Del Cluff.
Attribute
Focuses on details
Focuses on the big picture
Motivated by facts
Motivated by feelings
Focuses on the possible
Motivated by dreams
Analytic
Sympathetic
Interested in things
Interested in people
Inclined to gather a lot of information before
making a decision.
Inclined to decide quickly based on emotion
rather than facts.
Hap Castleton
x
x
Del Cluff
x
x
x
x
x
x
x
x
x
x
x
x
x
x
2. Why is it important to understand the values, personalities, and decision making model
Of a person you wish to communicate with?
This is important so then you can understand a person better and to know how to talk
to them about important things when trying to prove a point.
3. It is obvious Del Cluff has not established a good rapport with his boss Hap Castleton. To
what do you attribute the problem?
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This problem is most likely caused by how they don’t see eye to eye on certain
situations and how they are different in the case of one believing one thing will work
and how the other believes it won’t.
4. What are the differences in the ways Del Cluff and Hap Castleton process information,
and therefore make decisions?
The difference in the ways they think is that with Hap he thinks of others first and then
decides to do something to try and help them. Del thinks about what will happen to the
big picture and them tries to make decisions to try and support the main thing even if
some people don’t like it.
5. Given the differences in personality, values, and decision-making style, how could Del
Cluff be more efficient in communicating his concern about the hospital’s financial
condition to his boss Hap Castleton?
Del could be more efficient by explaining some of the numbers, such as how much debt
the hospital is in and how the hospital’s new budget would help it stay afloat financially.
Writing Exercise
6. Assume you are Del Cluff. From what you know about Hap Castleton, prepare a written
memo explaining your concerns about the hospital’s losses. Explain why you will not
oppose Edward Wycoff’s efforts to cut the hospital budget.
To Whom It May Concern, this note is to anyone wondering about if I will oppose
Edward Wycoff’s effort to cut the hospital budget. The truth is that I will not be
opposing Mr. Wycoff’s decision. Even with the recommendation to do so by Mr. Hap
Castleton, I will not oblige to his ways. This is due to the fact that I believe Mr. Hap
causes more problems than he fixes and doesn’t have a mind for finances. With that
said, I will stand behind Mr. Wycoff’s decision so then we will be able to help ourselves
with our own finances. –Del Cluff
Chapter 2
1. What are the advantages and disadvantages of selecting an interim administrator?
Some of the advantages include that they can help a hospital in a crisis and they can
also help with immediate financial trouble. They can also be a disadvantage by not
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being able to stay for long periods of time, it is hard to find a temporary one with a
lot of experience, and then workers have to deal with two administrators.
Chapter 3
1. Edward Wycoff felt Hap Castleton and Wes Douglas would make a good team, as
each would complement the strengths and weaknesses of the other. What are
the strengths and weaknesses of Hap and Wes?
2. Edward Wycoff related the story of several vice presidents of a large fortune 500
company who were successful while holding important jobs within the company,
but lost their fortunes when they tried to go into business for themselves. Why
did this happen? What can a supervisor learn from this experience?
This happened because they did not form a functional team to help lead their
businesses. A supervisor could learn in this experience the way to build an
effective team to run a business.
3. Why did Wes accept the offer to serve as interim administrator of Brannan
Community hospital? What did Wes Douglas have to win by accepting this offer,
and what might he have to lose? Place yourself in the role of Wes Douglas.
Would you accept the job?
He accepted it to increase his visibility in Park City. He could win more popularity
and a bigger business. He could lose whatever small reputation he has, and he
could be left with less money. I would not accept the job because I would already
have a good paying job and even though I wouldn’t get as popular, I would still
have a guaranteed income.
4. It has often been said; how someone does something is as important as what he
or she does. If you were chairperson of the board, would you have fired Selman?
Is there anything you would have done differently?
I would not have fired Selman. I would have blamed him partially for the
financial trouble, but I would keep him for his experience and knowledge. Also I
would not have displayed the same actions in the meeting as Wycoff in the
meeting.
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5. Assuming it was necessary to fire Roger Selman, What do you think of Wycoff’s
timing? ‘
Wycoff’s timing is completely off. He fired someone of great importance in a
great time of pressure and anxiety. This combination does not go well together
in the sense of moral and good hope. Wycoff single handedly caused a
ginormous amount of unneeded and unwanted stress.
6. What was the response of hospital employees to the appointment of Wes
Douglas as administrator? What might the board have done to ease his
transition?
Most of the board is surprised about Wes’s new position as administrator. They
are mostly surprised about how he has never worked in a hospital before now,
and that his only experience is in financing. They could have eased the transition
by being more open to him, and by welcoming him more than worry about him.
7. So long as the board does the right thing, does it matter what the employees or
the medical staff think of their actions?
Yes, the employees should still care about the actions of the board. Say if the
board cuts workers rates or hours to save money, there will be a benefit to
saving some money. Still the employees should care because that would affect
their lifestyles.
8. Where does authority come from: a title or credibility?
Authority most likely comes from a title, but usually people prefer authority to
come from someone who is credible and responsible.
9. What will Wes Douglas have to do to to build his credibility with the board, the
medical staff, and the employees?
With the board he will have to show them that he can get his work done and
have the responsibility to maintain his position. As for the medical staff and
employees, he will have to get to know them and communicate to them as if he
truly wants to help them and not speak from a higher up position and deliver
fake promises.
10. If an allied health employee has good technical skills, why is it important for him
or her to have political savvy and good communication skills as well?
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This is important because if a person has these technical skills he or she can be
very good at communicating with many people in a short amount of time. This
can help the flow of work and overall help greatly in the flow of everything
around the work place.
11. Birdie Bankhead, Hap Castleton’s secretary, believes Edward Wycoff may have
hidden motives in selecting Wes is there to take the blame and is there to insure
the success of the hospital.
12. Cystitisa. Gingivitisb. Hematologyc. Histologyd. Hypodermice. Liposuctionf. Necrophobiag. Necrosish. Ophthalmologisti. Orthodontistj. Tracheoscopic13. Assuming you are a healthcare practitioner talking to someone with no medical
training about a loved one who has been admitted to the hospital. Translate the
following into simple English the family can understand.
A.
B.
C.
D.
14. Assume you were asked to fire Roger Selman. Prepare an outline of what you
would say. Role-play the situation with another student in front of the class,
showing courtesy and kindness.
Chapter 4
1. The first meeting of Wes Douglas with Elizabeth Flannigan, director of
nursing, didn’t go well. If you were the new administrator, explain how you
might have established rapport with your new nursing director before
exploring a controversial topic such as cost reduction.
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I would have explained the tight belt around our cash at that point in time. I
also would have explained how I would work to help reduce cost and
increase efficiency in that field.
2. How can Planning for an important meeting with a supervisor, coworker, or
subordinate raise your chance of success? What issues might you want to
include in such a planning session?
Planning can always help for any occasion it helps plan for your tactics you
are talking about in your meeting. It helps you be prepared for any questions
that may arise and any other issues you may have. Some of the issues you
may have is when people are concerned about their work such as pay, hours,
and working conditions.
3. Emil Flagg, the representative of the medical staff on the board of Trustees,
is an important stakeholder in the operation of the hospital. What would
have been your approach in defusing Dr. Flagg’s anger during his first
meeting with the new hospital administrator?
I would have talked about the different plans I had made for all the different
staff groups as of the moment. I would also have addressed any questions
that any medical staff employee would have thought to ask me like all of the
other questions I answered.
4. From the conversations of hospital employees Wes Douglas monitored in the
hospital cafeteria, it is obvious the employees have a negative impression of
their new administrator. List possible reasons for this. If you were interim
administrator, how would you address this problem?
Some reasons for this is that there are probably doubts about how I could
turn the situation around when the hospital is in such a deep amount of
debt. Another reason is that I was hired by Wycoff, this could lead the staff
members to believe I wouldn’t be a good candidate for the position seeing as
how Wycoff wants to run everything himself.
5. Sometimes, people jump before they think. Wes Douglas, for example, is
having second thoughts about accepting the job of administration. Given
that he has accepted the job, what do you think is his best course of action?
Should he bail out, walking away from the commitments he has made to the
board, or hang in there and try to salvage the situation?
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Wes should hang in there because while it may not provide as much money
as his other job, this is a guaranteed salary. He also realizes how much this
hospital means to the community and he would like to see it saved.
6. Hank Ulman, president of the employee council, thinks he sees a vacuum in
leadership—one he is eager to fill. What are his motives? Does he have the
best interests of the hospital at heart? List several alternative courses of
action Wes Douglas might take in neutralizing Ulman’s efforts. List the
advantages and disadvantages of each course of action, telling what you
would do if you were the interim administrator.
Wes needs to talk to all employees to find out their concerns and possible
solutions to their concerns. An advantage of this would be gaining the
employees trust and insight into the issues. A disadvantage to this would be
you can’t always guarantee that every request can be fulfilled. This could
lead to hard feelings from some.
7. According to Wes Douglas, what is the role of the board, and what is the role
of the hospital administrator?
8. Wes Douglas canceled the meeting with Hank Ulman at the Union Hall. Why
did he take this course of action? How would you handle the situation?
9. During a telephone conversation between Wes and Edward Wycoff, Wycoff
expressed his wish to involve himself in solving the hospital’s operating
problems. What are the advantages and disadvantages of having a board
member involved in daily operations?
The advantages to having a board member involved in daily operations is
that he or she can be recognized and truly known for who they are. In Wes’s
case this can be good because he has good intentions for the hospital and
the more people that know who he is and how helpful he is, the better.
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10. Why are elevators and hospital cafeterias a good place for reconnaissance by
attorneys who have malpractice suits against the hospital? What
ramifications does this have for patient privacy? Is there a lesson for hospital
employees?
Elevators and hospital cafeterias are a good place for reconnaissance for
attorneys and mal practice suits against the hospital because these are
places for gossip and socializing. To this, the employees can talk about the
patients in both of these places and that would be a violation of privacy
toward the patients. A lesson for the hospital employees is that they should
learn to talk about something different and make sure to respect patient’s
privacy.
11. What do employees think of Edward Wycoff, chairperson of the finance
committee? Why do they think Wes Douglas is in Wycoff’s camp? Should
Wes Douglas distance himself from Wycoff?
Employees think that Wycoff is a person who doesn’t have the best interests
in the hospital. He just wants the hospital to last long enough to earn his fill
of money or to make sure that he doesn’t go under himself. People think that
Wes is in Wycoff’s camp because Wycoff hired him, and people think that
Wycoff hired someone just like himself to fill the position that was needed.
Wes Should try to distance himself from Wycoff to make sure people don’t
think that he is just like Wycoff, because almost nobody likes Wycoff for
what he’s done and what he is like.
12. If an employee believes she has two bosses, is there a possibility she will play
the one against the other?
This is a possibility, and she might do this to somehow benefit herself. She
could also do this to see the reaction with the two to see how one will effect
the other, and to see how one will act to the response of the other boss.
13. By telling Wycoff to stay out of operations, Wes offended one of his few
allies on the board. Was this the right action to take?
This was the right action to take because if the way Wes wanted to do his
job, he couldn’t do it because Wycoff would just get in the way of it and try
to stop him.
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14. What do you believe Wes Douglas’s purpose was in meeting with the
employees this early in his administration? What message would you have
sent to your employees in your first meeting?
The purpose of Wes’s meeting this early in his administration was to show his
personality and what he intended to do to help the hospital. The message I
would have sent to my employees is that I was here to help and that I
intended to do my best to provide my services where they would be needed.
15. List five characteristics of successful teams.
1.
2.
3.
4.
5.
Common Goals
An understanding of the role of each team member
An ability to meet the needs of each person on the team
Trust
Good communication
16. List four ingredients of good communications.
1.
2.
3.
4.
The sender
The message
The receiver
Feedback
Chapter 5
1. Some patients feel admission to a hospital is a dehumanizing experience. Explain
how hospitals strip patients of their personal identity. Can you think of examples
not cited in the textbook/novel? Why is it important to treat patients as individuals,
instead of numbers or diagnoses?
Hospitals can strip a person of their identity by just ushering them into the crowd
that is just a mass of patients. Also, even though it helps people identify the
patients, the clipboards at the end of each bed show that the patient is just another
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body waiting for treatment and that they are not an actual person with a personality
and life.
2. Traditionally, patients were not allowed to review the information in their medical
records. Do you think this was for the benefit of the patient or the healthcare
practioner? Why do you think this policy was changed in the Patients’ Bill of Rights?
I believe this was for the benefit of the patient because the patient probably has the
right to know their condition and how they can be treated. Also, they most likely
would like to know their medical records.
3. Use a search engine on the Internet to find the American Hospital Association’s
Patients’ Bill of Rights. Compare this to this to the Patients’ Bill of Rights as written
by the Administrative Council. Can you think of additional rights you might add to
the list submitted by Elizabeth Flannigan?
You should also have the right to end your own life when facing a terminal illness.
There might also be an addition added for those who abuse the system, that those
who purposely cause themselves bodily harm (drug abuse, physical torture, etc.) no
longer qualify for medical assistance therefore freeing up medical care for those
more deserving.
4. Write a memo to a hospital supervisor about your concern that your hospital is not
giving enough attention to preserving the dignity of their patients. Propose several
programs the supervisor can adopt to create less dehumanizing hospital care?
Care should be taken to understand the varied needs of individual patients.
Sometimes these needs are overlooked. Elderly and not so elderly patients are hard
of hearing and miss information that is given to them by hospital personnel. Also in
times of stress/illness patients might not be hearing all that is stating by hospital
personnel in the few moments allotted during rounds. All information given to
patients should be detailed in a written summary to be sent home with caregivers or
the patient to review once at home.
5. Like it or not, sooner or later there will be rationing of healthcare services.
Otherwise, the United States will eventually spend 100% of its income on
healthcare. A difficult question is how these resources will be rationed. For
example: Assuming two people need a transplant, and there is only one organ
available, what should be the rationing criteria? Possible criteria include:
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a. How important is the Person to Society? The problem with this approach is
deciding what we mean by “important.” Who is more important, a 65-year
old politician, or a 24-year old mother of four?
b. Ability to Pay: Do the rich have a greater right to life than the poor?
c. Age: Should an organ be given to the person with the most years left to live?
d. Probability of the Best Outcome: If one person has a 50% chance of living
with the new organ, and the other a 75% chance, should the second person
be given the organ?
e. Personal Responsibility for the Illness: Two people need a lung transplant.
One developed cancer from smoking, the other developed cancer from a
genetic defect. Should personal accountability be considered?
Required: Assume you have been appointed Secretary of Health and Human
Resources and have been asked to come up criteria you think would be fair.
Remember, in the real world there is sometimes no “right answer.” What this book
tries to do is help you recognize the difficult decisions healthcare policy makers face,
and provide experience in approaching difficult issues. The purpose of this question
is to get you to think.
Certainly there are people more deserving of an organ. Those on death row should
be excluded from the organ transplant list. If you take a life, obviously, your life
should not be spared at the risk of another’s. A politician should not be higher than
a PTA mom who has done more for her community. Organs should be given out by
best match, likelihood of success and the benefit to society if the person were to
live. It is a package deal.
6. Form the class into groups and, using the following form as a basis for discussion,
review each of the actual case studies presented at the end of this chapter. Use the
guidelines presented, and others you may think of to determine what the ethical
issue is, who the stakeholders are, and whether the concerned parties acted
ethically. Have a representative from each group report on their conclusions.
Guidelines for Answering Bioethical Questions
Free Agency
Self-determination and freedom. The right of a rational person
to self-rule and to generate personal decisions independently.
Questions to Ask:
Answers from Group Discussion:
1. Is the patient mentally and
legally competent?
2. Is there any evidence of
incapacity?
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3. If competent, what is the
patient stating about preference
for treatment?
4. If disabled, who is the patient’s
proper representative?
5. Has the patient expressed prior
preferences through advanced
directives?
6. Has the patient expressed prior
preferences through advanced
directives?
7. Is the patient’s right to choose
respected?
8. Has sufficient time been given
for the patient to discuss and
evaluate outcomes?
9.
10.
11.
12.
Equality
The health care system must treat all patients equally.
Questions to Ask:
Answers from Group Discussion:
1. Are there biases that might
prejudice the provider from
giving a proper evaluation of
the patient’s quality of life?
2. Are their family issues that
might influence treatment
decisions (exhausting the
estate through medical
bills)?
3. Are there other financial
factors that might influence
a proper evaluation of the
patient’s quality of life?
4. Are there conflicts of
interest with the provider
(doctor or hospital payment
for example) that might
influence the decision to
withdraw life support?
Other questions the group may raise
5.
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6.
7.
Kindness/Duty to do Good Deeds of mercy, kindness, charity and consideration for the
welfare of other people.
Questions to Ask:
Answers from Group Discussion:
1. What are the prospects with or
without treatment for a return
to a normal life?
2. What physical, mental, and
social shortfalls is the patient
likely to experience if the
treatment succeeds?
3. Are providers or others
influencing decisions about
treatment trying to see the
situation through the patient’s
eyes?
4. Is the provider giving the care
that provides the most benefit
to the patient?
Other questions the group may raise:
5.
6.
7.
8.
9.
Obligation to do no Harm Don’t hurt the patient – the overriding principle for everyone
that undertakes the treatment of patients
Questions to Ask:
Answers from Group Discussion:
1. Is there a plan with a justifiable
reason to forgo treatment?
2. If the treatment is experimental,
has the patient been
forewarned of the possible
adverse effects?
3. Are there plans for comfort and
the relief of pain?
Other questions the group may raise:
4.
5.
6.
Honesty
Is the health-care worker telling the truth?
Questions to Ask:
Answers from Group Discussion:
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1. Has the patient been given a
clear understanding of his or her
diagnosis?
2. Is the patient aware of the
different treatment options?
3. Does the patient know the
potential benefits and dangers
of each treatment option?
4. Is there any reason the patient
should not be told the truth
about his or her condition?
Other questions the group may raise:
5.
6.
Legality
Are the actions of the health-care provider consistent with state
and federal laws?
Questions to Ask:
Answers from Group Discussion:
1. Has the patient left a living will
or health-care proxy?
2. If there is a living will, do the
instructions clearly cover
treatments the patient does not
wish to receive such as his or
her wish not to receive CPR,
respiratory or chemotherapy?
Are there directives being
followed?
3. Does the living will descriptive
conditions (i.e. terminal illness,
permanent coma) for which the
patient would refuse treatment
or interventions. Are these
directives being followed?
Other questions the group may raise:
4.
5.
Chapter 6 Questions
1. Some patients feel admission to a hospital is a dehumanizing experience.
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Patients may feel like they are only a number or a bed to be filled and not an individual
person. They are a temperature or a blood pressure to be taken and not a person with
real feelings and a story. Caregivers are overworked and get tired of hearing the moans
and groans of the truly sick.
2. Using the internet, define the term “quality assurance.” How does the term apply to
healthcare?
“Quality assurance” is defined as the maintenance of a desired level of quality in a
service or product especially by means of attention to every stage of the process of
delivery or production. In a hospital this should be one of the first priorities because it
relates to the treatment of patients and their environment.
3. What is “peer review?” How does it work and in what ways is it an important
component of quality assurance?
Others working in the same field define “Peer review” as the evaluation of scientific,
academic or professional work. In a hospital setting this means that those working
closely with you will evaluate you and your skills. You should hold their opinion in high
regard, as this is how your skills will develop over time.
4. What is the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)
and what are its objectives?
In the US the JCAHO represents quality and certain performance standards, an
independent not for profit organization that certifies healthcare organizations.
5. What is patient dumping, and what factors do you think mandated legislators to make it
illegal?
Patient dumping is when a patient is referred to another hospital without an evaluation.
Then the hospital referring the hospital can refer fines up to tens of thousands of
dollars. The fact that mandated legislators to make it illegal was that it prevented
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patients from being referred without first checking their health and condition also it
prevented hospitals from getting rid of patients immediately.
6. What steps should the Credentials Committee take when reviewing the application for
admissions to the medical staff from a physician?
The steps they should take is that they should question the physician about his skill,
experience and knowledge of procedures. They should also address any other issues or
discomforts in his/her field.
7. What is a case manager and what is his or her responsibility within the hospital?
A case manager’s responsibility is to oversee the quality of care provided by doctors.
The case manager also visits floors and reviews medical records.
Chapter 8 Questions
1. Define the terms culture, ethnicity, race, and cultural blindness. How are they
different and how are they the same?
Culture-social, artistic and religious belief structures distinguishing a specific society.
Values and traditions handed down from one generation to the next.
Ethnicity-the unity that comes from a common religion, belief, language, and
culture.
Race-a classification system based on genetic characteristics such as the color of
skin, structure of hair, and so on.
Cultural blindness- a situation where people assume cultural differences do not
exist.
These terms are the same in the sense that they are all closely related when
discussing different cultures or races; they are used to generally define large groups
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of people as well. They are different by being able to also describe a group of people
in somewhat greater detail.
2. Holistic medicine believes the whole is greater than the sum of the parts. It teaches
that a health practitioner must not limit his or her attention to the biological
expression of disease, but must look at the patient as a whole. Holistic medicine
considers factors, including the patient’s religious beliefs and emotional state. How
does consideration of one’s culture fit into holistic medicine?
The consideration of one’s culture fits into holistic medicine by factoring in a persons
beliefs and current state. This can include how their religion affects their lifestyle
and how they think, to this care can be given in an appropriate manner to the
patient.
3. List several guidelines for communicating with people from different cultural groups.
When someone communicates with people from different cultural groups one
should speak clearly, show respect, never yell, verify the patient understands what is
being said, use gestures, summarize, and find an interpreter (maybe a family
member) if the patient doesn’t speak English.
4. Review legislation and court rulings on gender-based discrimination.
In 1920, congress approved the 19th amendment giving women the right to vote. In
1940, congress outlawed sex-based wage discrimination for firms with federal
contracts. In 1963 the Federal Equal Pay Act was passed and it made it requirement
to pay men and women the same for the same job. From the Title VVI of the Civil
rights Act of 1964, women where not allowed to be fired if they were pregnant and
it outlawed the practice of reserving a specific job for men or women. The Title IX of
the Education Amendment of 1972 outlawed sexual discrimination by universities
and colleges that receive federal funds. Finally, The Supreme Court has ruled women
must get the same fringe benefits as men, including social security, welfare, and
workers compensation.
5. What is the purpose of the Americans and Disabilities Act of 1990?
Its purpose was to ensure the prevention of discrimination towards employees with
disabilities who were qualified from employers.
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Chapter 9 Questions
1. Place yourself in the position of Wes Douglas, administrator of Brannan Community
Hospital. If the bank cancels the hospital’s line of credit, the hospital will close. Assume
you are preparing for the meeting. Write a brief statement of your goals for the
meeting, and what your approach will be.
My goals are to try my best to keep the hospital up and running in good condition. My
approach will be to try and reason with the bank in the fairest way possible that will
benefit both sides of the agreement.
2. Place yourself in the position of Arnold Wilson, vice president of Park City State Bank.
Assume you are preparing for the meeting. Write a brief statement of your goals for the
meeting and what your approach will be.
My goals would to ensure the bank isn’t digging itself a hole with the hospital’s loans, or
at least make sure the bank gets collateral for the loans. My approach will be to inform
the hospital chair members that they don’t have an option to not try and pay the bank
back or come up with a solution that will favor the bank.
3. Sometimes people criticize banks for not loaning money to organizations with bad
credit. Where does the money loan come from? Do banks have responsibilities beyond
profit?
The money from loans come from what the bank has in its deposits, they borrow it from
their customers. The banks also have the job of making sure that they still have their
customer’s money.
4. Why was it important to the bank that the hospital installs an accounting system?
This was important for the bank because then the hospital could start to try and get a
grasp on their spending’s and funds that they actually have.
5. Does Edgar Wycoff have the interests of the hospital employees in mind with his offer?
Is it ethical for Wycoff to profit from the death of the hospital?
Wycoff does not have the best interests of the hospital employees, he is trying to buy
time in order to make it seem like he is trying to help but actually wants the downfall of
the hospital to happen so he will somehow profit. This is not an ethical decision for
Wycoff, this is because he is purposely trying to get gain for himself at the downfall of
several hundred employees and patients.
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Chapter 10 Questions
1. Are the problems raised by the hospital department heads problems, or merely
symptoms of a larger problem? If they are symptoms, what might the larger problem
be?
These are merely symptoms of a larger problem. The larger problem is that all the forms
and tasks that are required of hospitals are very difficult to understand and there is not
enough formal training to understand how to fill them out or do the proper task.
2. Wes has received a long list of complaints from his first line superiors. He can’t solve
them all immediately. Assume you are the interim administrator. Set priorities for the
problems presented according to your opinion of their importance. Write brief
justifications of your priorities.
The Priorities are as follows: Managed care and budgeting systems are first because
they are the subjects that the employees don’t immediately understand. The next in line
is the reports; this issue needs to be resolved because there needs to be immediate
focus on the subject. The reports need to be in on time to maximize efficiency and
money. Finally, the poor service communication and unresponsive controller’s office is
last. This is because while there may be confusion on how to do things around the
workplace, it can be fixed somewhat easily and it is not the most pressing matter at
hand.
3. Several departments complained the accounting department was not helpful. The
department didn’t have a service orientation. Who are the customers of the accounting
department? Is accounting there only to crunch numbers, or does it have other
obligations?
4. Communication is of limited value if the receiver doesn’t understand it. One of Wes’s
department heads complained accountants use technical terms non-accountants have
trouble understanding. Is accounting the only department in the hospital where this is a
problem? How can hospital employees be more sensitive in the way they communicate
with the patients and the non-technical employees?
The other department that there is a communication error is in the nursing department,
many of the nurses complain that the doctors are very hard to understand most of the
time. The employees can be more sensitive towards how they communicate with
patients and non-technical employees by being kind and explaining what the terms
mean in words they can understand.
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5. If you were the supervisor of a department, and your employees didn’t have a service
orientation, how might you train them to be more sensitive to their mission?
I would train them by having mandatory sessions during or after work for about an hour
at a time trying to teach them the proper way to be sensitive to how they teat their
mission.
6. All of the following quotes by successful leaders follow one central theme. Taking
these ideas, write a one-page paper on failure as a stepping stone to success
Chapter 11 Questions
None
Chapter 12 Questions
None
Chapter 13 Questions
1. One reason healthcare costs have risen so dramatically over the past three decades is
the cost of technology. Name one action that health care professionals can take to help
contain technology costs.
One way the cost can be reduced is by not buying so much new technology at one time.
If there is enough equipment to suffice treatment of patients, then there is no
immediate need to buy new equipment.
2. According to Dr. Herb Krimmel, why did the administrator of St. Joseph’s Hospital build
a cancer treatment unit when there was an identical one right across the street from her
hospital? What impact did her decision have on the costs of healthcare in her
community?
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The administrator did this to try and increase the quality of the hospital. The impact of
her decision on the community was that it greatly increased the price of treatment
because both machines cost two million dollars each, and that has to be paid off.
3. What is a free market and what are the conditions for its survival? Does the healthcare
industry compete in a free market?
A free market is a market system in which there is a balance in why people need to buy
things, the cost of those things, and how many of those things are made at a time. In a
normal free market the consumer and the dealer of that product can manage things like
the price and come to an agreement. The healthcare industry doesn’t compete in a free
market because the provider of the services and products they supply, the consumer
doesn’t know much about and this and can’t bargain the price of what he or she needs
like at some other industry.
4. When you are shopping for a new pair of running shoes, how do you compare the
quality of the various brands you are considering? Do quality and price influence your
decision? Why is it healthcare consumers have difficulty judging the need for, and the
quality of, the services they receive?
I do lets these factors help influence my decisions when I make these types of decisions.
Healthcare consumers have difficulty judging the service they need because they don’t
know the information about the quality of the service they are being given. The doctors
and healthcare employees know all the facts about what you need and you don’t have a
clue.
5. According to Dr. Herb Krimmel, some hospitals don’t think the patient is their primary
customer. Who do they think the customer is and why?
They think the customers are the doctors; this is because the doctors always want
something new or want something else. With these wants and needs, the doctors
become a primary source of getting the hospital new things and that then brings in new
patients.
6. In 1972, health professionals could order diagnostic tests, laboratory tests, x-ray studies
and so on without significant review by insurance companies, employees, employers,
the government, and so on. The emphasis was on quality. Today the emphasis is on
quality and cost. What caused the change in emphasis to occur?
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This change occurred because now we have to think about how the cost of something
will affect the hospital in time. Too much spending could cause a very big issue today,
but back in 1972 the most important thing was quality no matter how much it cost.
7. Accessibility to healthcare for all people has become an important discussion topic in
the United States. Is there a fallacy in focusing solely on quality, If no one can afford the
product offered by the hospital?
There is not a fallacy on focusing on quality, this is because if hospitals focus solely on
quality the price will go through the roof and nobody would be able to receive care
since the price would be so high.
Chapter 14 Questions
1. Why would the ownership of a laboratory or x-ray unit by a doctor influence how
many lab or x-ray tests he or she orders? Should a doctor own laboratories and x-ray
units?
The ownership of a laboratory or x-ray machine by a doctor can cause them to ask
for more tests or x-rays than necessary, and this causes the patient to pay more than
necessary. Doctors should not own this kind of equipment because then they control
everything with them, including how many unnecessary tests and scans have to be
done.
2. What is a director of reimbursement? Why is this person an important part of the
administrative team? What do you think the training requirements should be for a
director of reimbursement?
A director of reimbursement is a person who controls the reimbursing of employees.
He is important in the administrative team because he controls a lot of the money
being handled. The training one should receive to take this position is courses in how
money should be transferred to people on how well they work.
Chapter 15 Questions
1. Before 1984 how did most insurance companies pay hospitals for the services they
provided?
They paid the hospitals by reimbursing them.
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2. If you were the administrator of a hospital that received full costs plus a profit of 3%
for the services your hospital provided, what is one way you could raise profits?
How strong are the incentives under cost reimbursements for the hospital to be
efficient?
I could raise profits by slightly increasing the costs of treatments for the patients to
help compensate for the costs and to increase profits. Reducing staff would also
create an increase in profits. Increasing costs to patients will have to be done
cautiously so that the hospital does not lose patients due to high costs. Also the
reduction in staff should not affect patient care, which could also result in losing
patients.
3. Give a one-paragraph history of Blue Cross. Why did Justin Ford Kimball, the
founder of Blue Cross, feel hospitals should be paid under a cost reimbursement
system?
Justin Kimball felt that hospitals were at risk of financial failure because they were
locally funded. Meaning that they did not receive funding from the government. He
felt that this made hospitals vulnerable to financial risk. By reimbursing hospitals
under a cost reimbursement system, this helped hospitals to be able to afford the
costly equipment required for patient treatment.
4. Why were most hospitals formed as nonprofit organizations? Did this influence the
type of payment received?
Hospitals were originally formed as a place to help people and not as a money
making business. Payment received varied from month to month, making it difficult
to run the hospital.
5. Define cost reimbursement and prospective payment. Are the incentives to control
costs the same under each of these systems? Why?
Cost reimbursement is when a price for a product or service is not finalized until
after the work is done. In prospective payment the payment is worked out ahead of
time. No, there is not the same incentives to control costs within both systems.
Under the prospective payment system controlling costs would be more important
or hospitals could lose money.
6. Before setting up prospective payment the federal government tried to control the
rise in healthcare costs through regulation. They reasoned they could control costs
by forcing hospitals to seek approval for all rate increases, similar to the practices
used at that time to regulate utilities. Why didn’t this work?
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This method did not work because unlike utilities, hospitals have a variety of
treatments and variables with each patient. This causes the approval of rate
increases to be difficult to manage.
7. Define the word” system” and give several examples of systems.
A system is an orderly and complex arrangement of parts. Examples: physiological,
economic, computer
8. What are the four components of a system?
Input, throughput, output, feedback
9. Explain what “backwards thinking” is, as it relates to systems.
Start with goal and work backwards to see how the goal can be accomplished.
10. The healthcare delivery system is like a mobile. Pressure or movement exerted on
one component exerts pressure on others. Give an example.
Hospitals want the high tech equipment which costs money to treat patients which
causes an increase in cost to patients.
11. Briefly review the attempts by governmental agencies to implement a form of
universal healthcare.
“Bill for Benefits of the Indigent and Insane” began to be introduced in the 19 th
century. This was the beginnings of universal health care. This bill was introduced
by many but never passed until 2010 and is now called “Patient Protection and
Affordable Care Act”.
12. What is an Accountable Health Organization (ACO) and what are its objectives?
This is a group of physicians that have come together to provide coordinated care
under the Affordable Care Act. They may be paid on prospective or capitation
payment plan.
13. Who are the stakeholders in the Patient Protection and Affordable Care Act?
Those who provide services, those who receive care and those who pay for
healthcare services.
14. List the objectives and possible adverse consequences of the Patient Protection and
Affordable Care Act.
The objective of the Affordable Care Act is to change the way healthcare is provided.
Some adverse consequences are lower compensation, shrinking independence,
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greater regulation and increased paperwork will lead to physician shortages. In fact,
some physicians have already announced retirement due to the Affordable Care Act.
15. How does pay for performance differ from other forms of incentive payment?
Pay for performance in the medical field requires that patients get better. There are
more circumstances on a patient’s outcome that can be regulated by the doctor.
Living environment, mental and family background, financial resources, etc.
Chapter 16 questions
6. Most Blue Clross organizations were established by hospital administrators to assure
hospital bills would be paid. Before the 1970s, the Board of Trustees of most Blue Cross
plans was mainly composed of hospital administrators. How might this arrangement
have discouraged programs like Blue Cross from challenging hospital costs?
7. What incentives are there for a health maintenance organization doctor to provide
adequate healthcare services? What is to keep the doctor from withholding needed
treatment?
10.
11. What is the downside to providing incentives for healthcare workers to cut healthcare
cost? Is it possible to control costs, while still providing a high quality of healthcare?
12. One of the healthcare revolutions Stoker mentioned was the consolation of
independent hospitals into large corporate-style hospital chains. What do you think
might be the advantages and disadvantages of this consolidation?
Chapter 17 Questions
1. In her conversation with Wes Douglas, Emma Chandler, Acting Controller had this to
say:
“It’s a different game today. In the old days, the purpose was to heal the patient,
regardless of the cost or the patient’s ability to pay. Hospitals were often inefficient
and sometimes outright wasteful, but they cooperated with each other in achieving
their goals. Today the goal for many administrators is to cut and save money, even
when the doctors, employees, and patients are treated less than honorably.”
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Assuming her observations are correct: (1) what contributed toe this change in
attitude, and (2) do you think it is possible for the healthcare industry to find a
middle ground?
2. As he becomes more familiar with the issues facing Brannan community Hospital,
Wes Douglas is less inclined to view many issues in black-and-white terms.
Castleton, Wycoff, Brannan, and the other wants quality and compassion. What
viewpoints do you agree with, or like Wes Douglass, do you find some merit in each
argument? Explain your positions.
3. Refer to question 2 above. How might each viewpoint, taken to an extreme, violate
ethical standards?
Chapter 18 Questions
2. Wes Douglas tells a story about a request to raise nurse staffing in his newborn nursery.
After witnessing a situation where a baby nearly died, he concluded: When you’re faced with
that situation, cost suddenly doesn’t seem that important. Is he right of is he just getting carried
away with his emotions?
Wes is right in this kind of situation because when there are lives on the line the cost for some
things don’t seem important.
4. Several years ago, an administrator in a metropolitan hospital was proposing the
purchase of fetal heart monitors for the Department of Obstetrics to his board of
Trustees. The equipment, maintenance, and training of the personnel would amount
to many hundreds of thousands of dollars. One astute businessperson, who was
serving as a trustee, asked how many babies the monitors would save. The
administrator replied “maybe two or three a year.” The board members then pulled
a calculator from his shirt pocket and determined the cost was about $50,000 a
baby. The board then discussed the question: “Is a baby worth $50,000?” The
answer they settled on explains the difficulty facing most healthcare workers.
“Probably not,” they said, unless it’s my baby.” Why are the daily operator’s
questions facing allied health workers different from those facing employees in
many other industries? Can you run a hospital like you would a bicycle
manufacturing plant?
His questions are different because his questions can decide people’s lives. You can’t
run a hospital like a bicycle manufacturing plant because unlike a hospital, the plant
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doesn’t deal with lives and how you can save them while juggling financial costs. All
the plant is worried about is making bicycles and gaining a profit, while the hospital
is concerned with lives and how to just make it by with the money they have.
Chapter 19 Questions
1. We live in a society that equates wealth with success. Given this value system an outside
observer might assume Edward Wycoff was a successful man. What has Mr. Wyckoff
sacrificed to achieve wealth and social prominence? Do you think it was worth it? Is it
possible to be financially successful and still have a rewarding family and social life?
What might Wycoff have done differently?
Wycoff had sacrificed his family to gain his financial success, he had no time for them
and they were separated because of his work. His success was definitely not worth his
sacrifice, every person needs a family and he just threw it away to get his money and
success. I do believe that if your family is loving and helpful enough then you can get
have a financially successful job, a rewarding family, and social life. Wycoff could have
done less work than he did and tried to spend more time with his family.
Chapter 21 Questions
1. One way that a person might judge the efficiency of a hospital is to compare the
number of hours of registered nurse time per-patient-day with that of other
hospitals. If Community Hospital uses four hours of registered nurse time perpatient-day, and the University Hospital uses six, it is possible the University
Hospital is less efficient than Community Hospital? What other explanations
might there be for the difference?
There is a possibility that University could be less efficient, this is possible
because there might be a mistake or error in the understanding of how long each
nurse is supposed to visit each patient. Also, this hospital could be bigger and
because of this they have more time to spare with each patient.
Chapter 22 Questions
1. Dr. Matt Brannan has made a mistake in the diagnosis of a young child. What
duty does he have towards the child’s family, the hospital, the medical staff,
and himself?
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He has the duty of telling the family about his mistake and apologizing to
them, he has to admit his mistake to his medical staff so then they can peer
review him, and his duty to self is to improve and not commit the same
mistake.
4. What is the difference between negligence and malpractice?
The difference is that negligence is caused by the carelessness of someone not
wanting to do something and malpractice is caused when someone does
something to get personal gain.
5. Who is responsible for risk management in the hospital?
The doctors are responsible.
10. List five sources of law in the U.S.
The United States Constitution, Individual state constitutions, common law, Statues
and ordinances, and Administrative regulations.
16. Give an example of abuse in a healthcare setting.
Assault and battery.
Chapter 23 Questions
None
Chapter 24 Questions
1. Briefly discuss the steps that Wes Douglas might take to cut direct materials
costs in his hospital?
He might order audits of different departments as well as different checkups
of all staff and supplies as well.
3. Emma Chandler is also concerned that the pharmacy is not making nightly
deposits. What problem might this suggest?
This might suggest that different employees could be taking money from the
hospital at night.
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